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Chinese ‘low-tar’ cigarettes do not deliver lower levels of nicotine and carcinogens
  1. Quan Gan1,
  2. Wei Lu2,
  3. Jiying Xu2,
  4. Xinjian Li2,
  5. Maciej Goniewicz1,3,
  6. Neal L Benowitz1,3,
  7. Stanton A Glantz1,4
  1. 1Center for Tobacco Control Research and Education, University of California, San Francisco, California, USA
  2. 2Shanghai Center for Disease Control and Prevention, Shanghai, China
  3. 3Division of Clinical Pharmacology and Experimental Therapeutics, Departments of Medicine and Biopharmaceutical Sciences, University of California, San Francisco, California, USA
  4. 4Department of Medicine and Cardiovascular Research Institute, UCSF Comprehensive Cancer Center, University of California, San Francisco, California, USA
  1. Correspondence to Stanton A Glantz, Center for Tobacco Control Research and Education, University of California, San Francisco, 530 Parnassus Avenue, Suite 366, San Francisco, California 94143-1390, USA; glantz{at}


Background Low-tar cigarette smoking is gaining popularity in China. The China National Tobacco Corporation (CNTC) promotes low-tar cigarettes as safer than regular cigarettes.

Methods A total of 543 male smokers smoking cigarettes with different tar yields (15 mg, regular cigarettes, 10–13 mg low-tar cigarettes and <10 mg low-tar cigarettes) were recruited in Shanghai, China, who then completed a questionnaire on smoking behaviour and provided a urine sample for analysis of the nicotine metabolites cotinine and trans-3′-hydroxycotinine. A total of 177 urine samples were selected at random for the analysis of the carcinogens polycyclic aromatic hydrocarbon metabolites (PAHs) (1-hydroxypyrene, naphthols, hydroxyfluorenes and hydroxyphenanthrenes) and the tobacco specific nitrosamine 4-(methylnitrosamino)-1-(3-pyridyl)-butanone (NNK) metabolites, 4-(methylnitrosamino)-1-(3-pyridyl)-butanol (NNAL) and NNAL-glucuronide. Values were normalised by creatinine to correct for possible distortions introduced by dilution or concentration of the urine.

Results Smokers of low-tar cigarettes smoked fewer cigarettes per day (p=0.001) compared to smokers of regular cigarettes. Despite this lower reported consumption, levels of cotinine, trans-3′-hydroxycotinine and PAHs in urine of people smoking low-tar cigarettes were not correlated with nominal tar delivery of the cigarettes they smoked. Urine concentrations of NNAL were higher in smokers of lower tar than higher tar cigarettes.

Conclusions Chinese low-tar cigarettes do not deliver lower doses of nicotine and carcinogens than regular cigarettes, therefore it is unlikely that there would be any reduction in harm. CNTC's promotion of low-tar cigarettes as ‘less harmful’ is a violation of the World Health Organization Framework Convention on Tobacco Control, which China ratified in 2005.

  • Addiction
  • carcinogens
  • nicotine reduction in cigarettes
  • smoking topography
  • tobacco products

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  • Funding This work was supported by National Cancer Institute Training Grant CA-113710, the William Cahan Endowment and the UCSF Bland Lane Center of Excellence on Secondhand Smoke funded by the Flight Attendants Medical Research Institute and the UCSF Helen Diller Family Comprehensive Cancer Center. Funding for laboratory infrastructure in the Division of Clinical Pharmacology at UCSF was provided by the National Institutes of Health, P30 DA012393.

  • Competing interests NLB serves as a paid consultant to pharmaceutical companies that are developing or that market smoking cessation medications. He also has been a paid expert witness in litigation against tobacco companies, including on issues related to light cigarettes. None of the other authors have any competing interests to declare.

  • Ethics approval This study was conducted with the approval of the UCSF and Shanghai CDC.

  • Provenance and peer review Not commissioned; externally peer reviewed.

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